|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]
|
Facility
IP
|
$0.63
|
|
|
Service Code
|
NDC 0904-6469-61
|
| Hospital Charge Code |
1711722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
NDC 68084-709-01
|
| Hospital Charge Code |
1711722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Senior |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
NDC 68084-709-11
|
| Hospital Charge Code |
1711722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Senior |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]
|
Facility
IP
|
$0.66
|
|
|
Service Code
|
NDC 68084-709-11
|
| Hospital Charge Code |
1711722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]
|
Facility
IP
|
$0.39
|
|
|
Service Code
|
NDC 65862-528-90
|
| Hospital Charge Code |
1711722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]
|
Facility
IP
|
$0.66
|
|
|
Service Code
|
NDC 68084-709-01
|
| Hospital Charge Code |
1711722
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
IP
|
$19,442.26
|
|
|
Service Code
|
APR-DRG 0223
|
| Min. Negotiated Rate |
$19,442.26 |
| Max. Negotiated Rate |
$19,442.26 |
| Rate for Payer: IEHP Medi-Cal |
$19,442.26
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
IP
|
$13,982.26
|
|
|
Service Code
|
APR-DRG 0222
|
| Min. Negotiated Rate |
$13,982.26 |
| Max. Negotiated Rate |
$13,982.26 |
| Rate for Payer: IEHP Medi-Cal |
$13,982.26
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
IP
|
$39,263.57
|
|
|
Service Code
|
APR-DRG 0224
|
| Min. Negotiated Rate |
$39,263.57 |
| Max. Negotiated Rate |
$39,263.57 |
| Rate for Payer: IEHP Medi-Cal |
$39,263.57
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
IP
|
$11,789.52
|
|
|
Service Code
|
APR-DRG 0221
|
| Min. Negotiated Rate |
$11,789.52 |
| Max. Negotiated Rate |
$11,789.52 |
| Rate for Payer: IEHP Medi-Cal |
$11,789.52
|
|
|
VERAPAMIL 120 MG TABLET [8528]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 0591-0345-01
|
| Hospital Charge Code |
1710498
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
VERAPAMIL 120 MG TABLET [8528]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 0904-2924-61
|
| Hospital Charge Code |
1710498
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
|
VERAPAMIL 120 MG TABLET [8528]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 0591-0345-01
|
| Hospital Charge Code |
1710498
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
VERAPAMIL 120 MG TABLET [8528]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 0904-2924-61
|
| Hospital Charge Code |
1710498
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 70069-271-01
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 70710-1643-1
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
OP
|
$5.99
|
|
|
Service Code
|
NDC 72485-108-05
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.09
|
| Rate for Payer: Dignity Health Senior |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
IP
|
$5.99
|
|
|
Service Code
|
NDC 72485-108-05
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
OP
|
$19.29
|
|
|
Service Code
|
NDC 51754-0203-1
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Adventist Health Commercial |
$3.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.98
|
| Rate for Payer: Blue Shield of California EPN |
$11.32
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.40
|
| Rate for Payer: Dignity Health Senior |
$16.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.94
|
| Rate for Payer: Heritage Provider Network Senior |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$14.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16.40
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
IP
|
$19.29
|
|
|
Service Code
|
NDC 51754-0203-2
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$14.47 |
| Rate for Payer: Adventist Health Commercial |
$3.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.25
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.06
|
| Rate for Payer: Heritage Provider Network Senior |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$14.47
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
OP
|
$19.29
|
|
|
Service Code
|
NDC 51754-0203-2
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Adventist Health Commercial |
$3.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.98
|
| Rate for Payer: Blue Shield of California EPN |
$11.32
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.40
|
| Rate for Payer: Dignity Health Senior |
$16.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.94
|
| Rate for Payer: Heritage Provider Network Senior |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$14.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16.40
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 70710-1643-1
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 70069-271-01
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 70069-271-25
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 70710-1643-5
|
| Hospital Charge Code |
1720156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
